Considerations about the use of Ozone therapy (O3) in the treatment of Endometriosis
DOI:
https://doi.org/10.33448/rsd-v9i9.7616Keywords:
Ozone; Ozonetherapy; Endometriosis.Abstract
Endometriosis is defined as the presence of an endometrial gland and / or endometrial stroma outside the uterus. Endometriosis patients have a clinical picture with a lot of variability, with the prevalence of symptomatic dysmenorrhea, dyspareunia, chronic pelvic pain, dysuria, dyschezia and infertility. Currently, it is widely accepted that endometriosis is a disease associated with a general inflammatory response in the peritoneal cavity and that oxidative stress has been proposed as a potential factor involved in the pathophysiology of the disease. In this context, it is important to search for innovative and low-cost therapeutic alternatives, capable of preventing and / or decreasing the progression of tissue damage and mitigating the impacts inherent to the disease. Thus, this study seeks, through narrative review, to provide an understanding of the current available evidence regarding the importance of ozone therapy and its possible applicability in the treatment of endometriosis. Evidence shows that ozone has the ability to improve body oxygenation, modulate the inflammatory process, increase the antioxidant and immune system, help to alleviate diseases caused by oxidative damage similar to the complications of endometriosis. Thus, the evidence found in this study indicates that ozone therapy could be proposed as an effective and safe therapeutic intervention in the treatment of endometriosis, within the integrative practices. However, there are no controlled, randomized clinical trials that have evaluated the effect of ozone therapy on the prevention, control and treatment of endometriosis.
References
Alexandre, A., Corò, L., Paradiso, R., Dall'aglio, R., Alexandre, A. M., Fraschini, F., & Spaggiari, P. G. (2011). Treatment of symptomatic lumbar spinal degenerative pathologies by means of combined conservative biochemical treatments. Acta neurochirurgica. Supplement, 108, 127–135. https://doi.org/10.1007/978-3-211-99370-5_20
Alpay, Z., Saed, G. M., & Diamond, M. P. (2006). Female infertility and free radicals: potential role in adhesions and endometriosis. Journal of the Society for Gynecologic Investigation, 13(6), 390–398. https://doi.org/10.1016/j.jsgi.2006.05.002
Atallah, N. A, Castro, A. A. Revisão sistemática da literatura e metanálise: a melhor forma de evidência para tomada de decisão em saúde e a maneira mais rápida de atualização terapêutica. Disponível em: http://www.epm.br/Cochrane
Anzolin, Ana Paula, & Bertol, Charise Dallazem. (2018). Ozonioterapia como terapêutica integrativa no tratamento da osteoartrose: uma revisão sistemática. BrJP, 1(2), 171-175. https://dx.doi.org/10.5935/2595-0118.20180033
Augoulea, A., Mastorakos, G., Lambrinoudaki, I., Christodoulakos, G., & Creatsas, G. (2009). The role of the oxidative-stress in the endometriosis-related infertility. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 25(2), 75–81. https://doi.org/10.1080/09513590802485012
Barbosa, Kiriaque Barra Ferreira, Costa, Neuza Maria Brunoro, Alfenas, Rita de Cássia Gonçalves, De Paula, Sérgio Oliveira, Minim, Valéria Paula Rodrigues, & Bressan, Josefina. (2010). Estresse oxidativo: conceito, implicações e fatores modulatórios. Revista de Nutrição, 23(4), 629-643. https://doi.org/10.1590/S1415-52732010000400013
Bazot, M., Malzy, P., Cortez, A., Roseau, G., Amouyal, P., & Daraï, E. (2007). Accuracy of transvaginal sonography and rectal endoscopic sonography in the diagnosis of deep infiltrating endometriosis. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 30(7), 994–1001. https://doi.org/10.1002/uog.4070
Bellelis, P., Dias, J. A., Jr, Podgaec, S., Gonzales, M., Baracat, E. C., & Abrão, M. S. (2010). Epidemiological and clinical aspects of pelvic endometriosis–a case series. Revista da Associacao Medica Brasileira (1992), 56(4), 467–471. https://doi.org/10.1590/s0104-42302010000400022
Bocci V. (1999). Biological and clinical effects of ozone. Has ozone therapy a future in medicine?. British journal of biomedical science, 56(4), 270–279.
Bocci V. (2006). Is it true that ozone is always toxic? The end of a dogma. Toxicology and applied pharmacology, 216(3), 493–504. https://doi.org/10.1016/j.taap.2006.06.009
Bocci, V., Zanardi, I., & Travagli, V. (2011). Oxygen/ozone as a medical gas mixture. A critical evaluation of the various methods clarifies positive and negative aspects. Medical gas research, 1(1), 6. https://doi.org/10.1186/2045-9912-1-6
Bocci, V. A., Zanardi, I., & Travagli, V. (2011). Ozone acting on human blood yields a hormetic dose-response relationship. Journal of translational medicine, 9, 66. https://doi.org/10.1186/1479-5876-9-66
Binda, M. M., Molinas, C. R., & Koninckx, P. R. (2003). Reactive oxygen species and adhesion formation: clinical implications in adhesion prevention. Human reproduction (Oxford, England), 18(12), 2503–2507. https://doi.org/10.1093/humrep/deg481
Braidy, N., Izadi, M., Sureda, A., Jonaidi-Jafari, N., Banki, A., Nabavi, S. F., & Nabavi, S. M. (2018). Therapeutic relevance of ozone therapy in degenerative diseases: Focus on diabetes and spinal pain. Journal of cellular physiology, 233(4), 2705–2714. https://doi.org/10.1002/jcp.26044
Bulun S. E. (2009). Endometriosis. The New England journal of medicine, 360(3), 268–279. https://doi.org/10.1056/NEJMra0804690
Da Broi, M. G., & Navarro, P. A. (2016). Oxidative stress and oocyte quality: ethiopathogenic mechanisms of minimal/mild endometriosis-related infertility. Cell and tissue research, 364(1), 1–7. https://doi.org/10.1007/s00441-015-2339-9
Davis, Colin J.a; McMillan, Lindsayb Pain in endometriosis: effectiveness of medical and surgical management, Current Opinion in Obstetrics and Gynecology: December 2003 - Volume 15 - Issue 6 - p 507-512
Di Paolo, N., Bocci, V., & Gaggiotti, E. (2004). Ozone therapy. The International journal of artificial organs, 27(3), 168–175. https://doi.org/10.1177/039139880402700303
Đuričić, D., Valpotić, H., & Samardžija, M. (2015). Prophylaxis and therapeutic potential of ozone in buiatrics: Current knowledge. Animal reproduction science, 159, 1–7. https://doi.org/10.1016/j.anireprosci.2015.05.017
Đuričić, D., Valpotić, H., Žura Žaja, I., & Samardžija, M. (2016). Comparison of Intrauterine Antibiotics versus Ozone Medical Use in Sheep with Retained Placenta and Following Obstetric Assistance. Reproduction in domestic animals = Zuchthygiene, 51(4), 538–540. https://doi.org/10.1111/rda.12715
Fauconnier, A., Fritel, X., & Chapron, C. (2009). Relations entre endométriose et algie pelvienne chronique: quel est le niveau de preuve? [Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications]. Gynecologie, obstetrique & fertilite, 37(1), 57–69. https://doi.org/10.1016/j.gyobfe.2008.08.016
Francisco, Viviane Vieira, D'Ippolito, Giuseppe, Silva, Gláucia Palácio de Andrade e, Bezerra, Alexandre Sérgio de Araújo, & Szejnfeld, Jacob. (2005). Prevalência de artefatos em exames de ressonância magnética do abdome utilizando a seqüência GRASE: comparável com as melhores seqüências rápidas?. Radiologia Brasileira, 38(5), 323-328. https://doi.org/10.1590/S0100-39842005000500003
Guerra XV, Limonta YN, Contreras IH, Freyre RL, Ramírez AMP. Resultados de los costos en ozonoterapia. Rev Cubana Enfermer 1999;15(2):104-108.
Gupta, S., Goldberg, J. M., Aziz, N., Goldberg, E., Krajcir, N., & Agarwal, A. (2008). Pathogenic mechanisms in endometriosis-associated infertility. Fertility and sterility, 90(2), 247–257. https://doi.org/10.1016/j.fertnstert.2008.02.093
Hahn, G., Oliveira, J., & Bock, P. (2017). O papel do fator nuclear eritróide 2 relacionado ao fator 2 (Nrf2) no diabetes mellitus. Clinical & Biomedical Research, 37(3). Retrieved from https://seer.ufrgs.br/hcpa/article/view/73
Hernández OD, González RC. Ozonoterapia en úlceras flebostáticas. Rev Cubana Cir 2001;40(2):123-129.
Hsu, A. L., Khachikyan, I., & Stratton, P. (2010). Invasive and noninvasive methods for the diagnosis of endometriosis. Clinical obstetrics and gynecology, 53(2), 413–419. https://doi.org/10.1097/GRF.0b013e3181db7ce8
Joseph, J., Ametepe, E. S., Haribabu, N., Agbayani, G., Krishnan, L., Blais, A., & Sad, S. (2016). Inhibition of ROS and upregulation of inflammatory cytokines by FoxO3a promotes survival against Salmonella typhimurium. Nature communications, 7, 12748. https://doi.org/10.1038/ncomms12748
Kaspar, J. W., Niture, S. K., & Jaiswal, A. K. (2009). Nrf2:INrf2 (Keap1) signaling in oxidative stress. Free radical biology & medicine, 47(9), 1304–1309. https://doi.org/10.1016/j.freeradbiomed.2009.07.035
Kennedy, S., Bergqvist, A., Chapron, C., D'Hooghe, T., Dunselman, G., Greb, R., Hummelshoj, L., Prentice, A., Saridogan, E., & ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group (2005). ESHRE guideline for the diagnosis and treatment of endometriosis. Human reproduction (Oxford, England), 20(10), 2698–2704. https://doi.org/10.1093/humrep/dei135
Kobayashi, E. H., Suzuki, T., Funayama, R., Nagashima, T., Hayashi, M., Sekine, H., Tanaka, N., Moriguchi, T., Motohashi, H., Nakayama, K., & Yamamoto, M. (2016). Nrf2 suppresses macrophage inflammatory response by blocking proinflammatory cytokine transcription. Nature communications, 7, 11624. https://doi.org/10.1038/ncomms11624
Lemos, N. A., Arbo, E., Scalco, R., Weiler, E., Rosa, V., & Cunha-Filho, J. S. (2008). Decreased anti-Müllerian hormone and altered ovarian follicular cohort in infertile patients with mild/minimal endometriosis. Fertility and sterility, 89(5), 1064–1068. https://doi.org/10.1016/j.fertnstert.2007.04.048
Lousse, J. C., Van Langendonckt, A., Defrere, S., Ramos, R. G., Colette, S., & Donnez, J. (2012). Peritoneal endometriosis is an inflammatory disease. Frontiers in bioscience (Elite edition), 4, 23–40. https://doi.org/10.2741/358
Maul, L. V., Morrision, J. E., Schollmeyer, T., Alkatout, I., & Mettler, L. (2014). Surgical therapy of ovarian endometrioma: recurrence and pregnancy rates. JSLS : Journal of the Society of Laparoendoscopic Surgeons, 18(3), e2014.00223. https://doi.org/10.4293/JSLS.2014.00223
Melo, V. L., Sá, S. P. C., Passos, M. B. P., Ferreira, J. B. dos S., Alóchio, K. V., Sardinha, M. T. M. U., & Christóvam, B. P. (2020). Ozonioterapia realizada pelo Enfermeiro na imunomodulação em paciente com “Craurose vulvar”: relato de experiência. Research, Society and Development, 9(8). https://doi.org/10.33448/rsd-v9i8.6153
Menendez-Cepero S. General protocols based on evidences. Proceedings of the 5Th WFOT Meeting; 2016 Nov 18-20; Mumbai, India. J Ozone Ther. 2018;2(2). doi: 10.7203/ jo3t.2.2.2018.11125
Mengarda, C. V., Passos, E. P., Picon, P., Costa, A. F., & Picon, P. D. (2008). Validação de versão para o português de questionário sobre qualidade de vida para mulher com endometriose (Endometriosis Health Profile Questionnaire--EHP-30) [Validation of Brazilian Portuguese version of quality of life questionnaire for women with endometriosis (Endometriosis Health Profile Questionnaire--EHP-30)]. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 30(8), 384–392. https://doi.org/10.1590/s0100-72032008000800003
Murphy, A. A., Santanam, N., Morales, A. J., & Parthasarathy, S. (1998). Lysophosphatidyl choline, a chemotactic factor for monocytes/T-lymphocytes is elevated in endometriosis. The Journal of clinical endocrinology and metabolism, 83(6), 2110–2113. https://doi.org/10.1210/jcem.83.6.4823
Pacheco, José Fernando, Dias, Rogério, Silva, Márcia Guimarães da, Tristão, Andréa da Rocha, & De Luca, Laurival Antônio. (2003). Prevenção de aderências pélvicas: estudo experimental em ratas com diferentes modalidades terapêuticas. Revista Brasileira de Ginecologia e Obstetrícia, 25(5), 359-364. https://doi.org/10.1590/S0100-72032003000500009
Pereira A.S. et al. (2018). Metodologia da pesquisa científica. Santa Maria, RS : UFSM, NTE, 2018. Disponível em: https://repositorio.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1. Acesso em: 17 de agosto de 2020.
Pecorelli, A., Bocci, V., Acquaviva, A., Belmonte, G., Gardi, C., Virgili, F., Ciccoli, L., & Valacchi, G. (2013). NRF2 activation is involved in ozonated human serum upregulation of HO-1 in endothelial cells. Toxicology and applied pharmacology, 267(1), 30–40. https://doi.org/10.1016/j.taap.2012.12.001
Re, L., Martínez-Sánchez, G., Bordicchia, M., Malcangi, G., Pocognoli, A., Morales-Segura, M. A., Rothchild, J., & Rojas, A. (2014). Is ozone pre-conditioning effect linked to Nrf2/EpRE activation pathway in vivo? A preliminary result. European journal of pharmacology, 742, 158–162. https://doi.org/10.1016/j.ejphar.2014.08.029
Recio del Pino, Eulalia, Arias Serrano, Maritza, Rodríguez del Río, Magalys, & Garrido, María de los Angeles. (1999). Aspectos de la ozonoterapia en pacientes con neuropatía periférica epidémica. Revista Cubana de Enfermería, 15(2), 114-118. Recuperado en 07 de agosto de 2020, de http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-03191999000200010&lng=es&tlng=es.
Revised American Society for Reproductive Medicine classification of endometriosis: 1996. (1997). Fertility and sterility, 67(5), 817–821. https://doi.org/10.1016/s0015-0282(97)81391-x
Ruder, E. H., Hartman, T. J., Blumberg, J., & Goldman, M. B. (2008). Oxidative stress and antioxidants: exposure and impact on female fertility. Human reproduction update, 14(4), 345–357. https://doi.org/10.1093/humupd/dmn011
Rushworth, S. A., Zaitseva, L., Murray, M. Y., Shah, N. M., Bowles, K. M., & MacEwan, D. J. (2012). The high Nrf2 expression in human acute myeloid leukemia is driven by NF-κB and underlies its chemo-resistance. Blood, 120(26), 5188–5198. https://doi.org/10.1182/blood-2012-04-422121
Schug, T. T., Xu, Q., Gao, H., Peres-da-Silva, A., Draper, D. W., Fessler, M. B., Purushotham, A., & Li, X. (2010). Myeloid deletion of SIRT1 induces inflammatory signaling in response to environmental stress. Molecular and cellular biology, 30(19), 4712–4721. https://doi.org/10.1128/MCB.00657-10
Thimmulappa, R. K., Lee, H., Rangasamy, T., Reddy, S. P., Yamamoto, M., Kensler, T. W., & Biswal, S. (2006). Nrf2 is a critical regulator of the innate immune response and survival during experimental sepsis. The Journal of clinical investigation, 116(4), 984–995. https://doi.org/10.1172/JCI25790
Travagli, V., Zanardi, I., Bernini, P., Nepi, S., Tenori, L., & Bocci, V. (2010). Effects of ozone blood treatment on the metabolite profile of human blood. International journal of toxicology, 29(2), 165–174. https://doi.org/10.1177/1091581809360069
Viebahn-Hänsler R, León-Fernández OS, Fahmy Z. Systemic ozone applications, Major autohemotherapy and Rectal Insufflation, evaluated according to the International classification of Evidence-Based Medicine. A new basis for reimbursement of medical expenses by private and social insurances [abstract]. Proceedings of The World Conference on Ozone Therapy in Medicine, Dentistry and Veterinary. Ancona (Italy). September 22nd – 23rd - 24th , 2017. J Ozone Ther. 2019;3(4):78. doi: 10.7203/jo3t.3.4.2019.15550
Wang, G., Tokushige, N., Markham, R., & Fraser, I. S. (2009). Rich innervation of deep infiltrating endometriosis. Human reproduction (Oxford, England), 24(4), 827–834. https://doi.org/10.1093/humrep/den464
Wykes, C. B., Clark, T. J., & Khan, K. S. (2004). Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic quantitative review. BJOG : an international journal of obstetrics and gynaecology, 111(11), 1204–1212. https://doi.org/10.1111/j.1471-0528.2004.00433.x
Yu, G., Liu, X., Chen, Z., Chen, H., Wang, L., Wang, Z., Qiu, T., & Weng, X. (2016). Ozone therapy could attenuate tubulointerstitial injury in adenine-induced CKD rats by mediating Nrf2 and NF-κB. Iranian journal of basic medical sciences, 19(10), 1136–1143.
Merhi, Z., Garg, B., Moseley-LaRue, R., Moseley, A. R., Smith, A. H., & Zhang, J. (2019). Ozone therapy: a potential therapeutic adjunct for improving female reproductive health. Medical gas research, 9(2), 101–105. https://doi.org/10.4103/2045-9912.260652
Zobel R, Martinec R, Ivanović D, Rošić N, Stančić Z, et al. (2014) Intrauterine ozone administration for Intrauterine ozone administration for improving fertility rate in Simmental cattle improving fertility rate in Simmental cattle. Veterinarski Arhiv 84(1): 1-8.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Jynani Pichara Morais; Carla Roberta Tim; Livia Assis
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.